Editorial: A logical repair plan for Obamacare

Lost among much of the criticism of the Affordable Care Act is that it still is insurance.

Apart from the total number of those insured, which has been the focus so far, the mix of healthy and sick must be right.

Premiums must cover expenses.

That is why the “young invincibles” need to be persuaded to sign up.

One warning sign has been noted by respected analyst Robert Laszewski on his health care reform blog.

Several health insurance companies have predicted premiums will have to increase by double digits in 2015. If that happens, Laszewski writes, “Obamacare is finished.”

Double-digit increases would indicate that too many sick people are joining and too few healthy people are. That is why a mandate was a conservative idea and supported by the insurance companies.

Increasing the rates, however, only makes it more difficult to get healthy people to sign up. This is called “a death spiral” in the insurance business.

Laszewski’s solution is to allow insurance companies to offer more options that still include at least 60 percent of the actuarial minimum of coverage.

Some conservative Democrats interested in fixing Obamacare support that.

Republican alternatives so far have plenty of downsides often involving reducing access and coverage.

One credible idea is to return to a 5 to 1 premium difference between young and old. Obamacare cut the difference to 3 to 1, which meant the young are subsidizing the old.

The political realities are that Republicans won’t be able to make radical changes in the system until 2017, presuming there is a Republican president and a Republican Congress.

Popular parts of Obamacare — such as not dropping people for pre-existing conditions — will have become standard by then.

Laszewski expects Obamacare to “limp along for a few years.” Eventually it must be fixed, he writes.

“It is a mess as it is.”

Fix it, don’t repeal it is the best solution.

EXCEPTIONS TO OBAMACARE

There have been nearly 40 exceptions to the Affordable Care Act, mostly done unilaterally by the Obama administration.

■ The employer mandate was suspended.

■ Some health plans were given a temporary exemption from minimum coverage requirements for some Americans whose plans did not match Obamacare’s requirements.

■ Some Americans are allowed to claim hardship and avoid penalties.

THE CLOUDY HEALTH CARE MARKET

The health care market is obscure. Many physicians can’t even say how much their procedures cost.

Only 1 in 5 orthopedic surgeons know how much an artificial hip or knee costs, Kaiser Health News reports.

Surgeons never see the cost displayed, and it’s difficult to find in any case.

Hospitals have a financial incentive to use cheaper devices because Medicare pays a lump sum. But surgeons tend to favor certain manufacturers, and hospitals are reluctant to get involved. Some doctors receive consulting fees or royalties from manufacturers.